Seven Years of LTD Benefits Did Not End Aetna’s Review
A long-paid claim can still face renewed scrutiny
For roughly seven years, Maree Young received long-term disability benefits under TD Bank’s group plan. She had worked in a largely sedentary but cognitively demanding information-technology position. Aetna approved her LTD claim in November 2016 following her cyclic-vomiting-syndrome diagnosis.
Aetna terminated the benefits in November 2023. Young pursued an internal appeal, submitting provider statements, earlier neuropsychological testing, a functional assessment, and a vocational report. After Aetna denied the appeal in September 2024, she filed an ERISA lawsuit in federal court.
The case illustrates a difficult reality for claimants: years of benefit payments do not necessarily prevent an insurer from reassessing whether the plan’s definition of disability remains satisfied.
Why the standard of review mattered
The plan required continuing proof of disability and gave Aetna discretion to decide benefit eligibility. Young argued that a 2019 Maine law prohibiting discretionary clauses should apply. The court disagreed because the record did not show that this pre-2019 policy had been continued or renewed after the law took effect. Continued benefit payments, standing alone, did not establish a policy renewal.
That ruling led the court to apply a deferential standard, asking whether substantial evidence supported Aetna’s decision rather than deciding the claim from scratch.
The court recognized that Aetna both evaluated claims and bore responsibility for paying benefits, creating a conflict of interest. It gave that conflict some weight, but little. It also considered Young’s 2018 Social Security disability determination and Aetna’s history of paying benefits. Neither, the court held, bound Aetna or displaced Young’s obligation to provide continuing proof under the plan.
The evidence that worked against the claim
Young had neuropsychological evaluations from 2016, 2017, and 2020 documenting disabling cognitive problems. The court expressed sympathy for her cognitive-impairment argument. Even so, it concluded that Aetna could rely on more recent evidence, including an independent medical examination and physician reviews, together with the absence of updated neuropsychological testing.
The court also found evidence that Young’s vomiting episodes had become less frequent and that their physical effects had diminished by 2023. Although Aetna had obtained shopping surveillance, the court described it as “not terribly useful.” Surveillance was therefore not the decisive point.
Ultimately, the court granted Aetna’s motion for summary judgment, denied Young’s motion, and dismissed the complaint with prejudice. It did not award benefits, reinstate the claim, or order a remand.
Practical lessons for ERISA claimants
As a practical inference—not a universal rule—someone receiving ongoing LTD benefits should understand the plan’s continuing-proof requirements and keep functional evidence current, particularly when cognitive symptoms affect work capacity in ways that ordinary office notes may not fully capture. Prior approval and a Social Security award can be important, but they may not carry an ERISA claim through a later review by themselves.
If Aetna or another insurer is reviewing or terminating a disability claim, Feden Law Group’s disability benefits practice can help assess the policy, administrative record, and appeal strategy. You may schedule an initial consultation.
Case: Young v. Aetna Life Insurance Co., No. 24-CV-4611 (PJS/DTS) (D. Minn. Sept. 24, 2026). Read the public opinion.
This article provides general information only and is not legal advice. Reading it or contacting Feden Law Group does not create an attorney-client relationship.